Patients are being forced onto a conveyor belt of misery by the decimation of health and social care.
Years of Tory budget cuts and privatisation are pushing the NHS past breaking point, hitting patients hard. While hospital services are slashed, poverty pay and rocketing workloads are forcing health workers out.
Deep cuts to local authority social care and mental health services are fuelling the crisis (see below).
Marfa, a junior doctor, described what this means for patients she’s treated. “We had an elderly guy with us one time,” she told Socialist Worker. “He had dementia and quite challenging behaviour.
“He had been in hospital for two weeks and was well by then, but he couldn’t leave for weeks.”
This is because there aren’t enough social care packages, which are agreed between the hospitals, local authorities and sometimes charities. At hospitals, a discharge team works to determine what sort of care patients need after they leave.
Sometimes this can mean going to a hospital rehabilitation unit, getting equipment fitted at home so patients can live independently or having a social worker visit.
But if “all other options have been explored” patients can be sent to a residential care home.
Marfa said that this can be one of the most difficult and tortuous processes for patients. “If you’ve got complex dementia, like the guy we had, there are only certain care homes you can go to,” she said.
This is bogged down through a process of Health and Social Care Panels, which decide how a care home place is going to be funded.
“The funding is split between health and social care budgets and these panels decide which one it’s going to come from,” she said. “But the money all comes from the Treasury so I don’t think it should really matter.”
The money exists to fund care services properly. But instead the Tories hand tax cuts to the rich and multi-million pound contracts to firms profiting from, rather than providing, the care that’s needed.
It is the patients who suffer under this process of false starts. “This elderly guy had been through the panel for six weeks,” Marfa said. “If the paperwork isn’t quite right the case can’t go through, but the panel only meets once a week.”
“It’s been like this for the whole four years since I became a doctor—the whole panel system is broken.”
Cathy, an occupational therapist (OT) who works on an elderly care ward, has dealt with similar cases. “Seven years ago you still had elderly people saying, ‘Please don’t send me to a care home,’ but now they’re begging to be sent,” she told Socialist Worker.
“If they’re sent home they are bed-bound and socially isolated—I had one man who told his carers that he couldn’t wait for death.”
After patients receive care from health workers such as Marfa, OTs then take charge of assessing their needs for when they are discharged.
There are a lot of people sitting on wards wanting to go home
Occupational therapist Cathy
Health care shouldn’t just be based on administering medicine or treatment, but a holistic approach to patients’ wellbeing. As Cathy explained, “The people we look after are quite complex.
“I had one woman recently who was self-neglecting. She was in a really filthy and awful home, she wasn’t feeding herself, she had been crawling around for months trying to get to the toilet.”
But the pressure caused by the lack of resources and staff means that there are 1.2 million people who can’t get the level of care they need.
The lack of social care packages can also impact people’s physical and mental health.
As Cathy explained, “There are a lot of people sitting on wards wanting to go home.
“I had one guy on our ward go home today, but he was all packed up and ready to go for three weeks before that. That was making him really demoralised and anxious.”
At Cathy’s hospital there used to be an intermediate care facility for people waiting for social care packages, or whose homes weren’t accessible.
“Until this facility closed down, people would get rehab there but be out of the hospital setting,” she said. “Now people are just sitting on a ward getting infected.”
This builds up pressure to get people out as quickly as possible.
Cathy said, “It takes a lot of time to find care packages and it’s all last minute because of care agencies and funding.
“There’s pressure to downgrade packages. If they had proper rehab beforehand we could reduce their needs, but there’s so many people coming in.
“We’ve had 25 new admissions in the last three days.”
During the last 30 years hospital admissions have nearly doubled to more than 16 million—in large part due to people living longer.
Yet the number of beds has more than halved to just over 130,000.
In the run-up to Christmas last year, many hospitals were running at bed occupancy rates of 90 percent and had to close wards to new admissions.
Across England bed occupancy rates hover around 89 percent and have not dropped below the recommended 85 percent for 15 years.
Marfa said, “The problem goes further than discharging patients—we just don’t have enough beds. Earlier this year we had an influenza outbreak at my hospital and it got to the point where we didn’t just run out of beds. There weren’t any trolleys or anything for people.”
The acute shortage of beds shows how the health and social care crises feed into one another.
This creates a revolving door of going into hospital and waiting to be discharged. If pressure builds up and people are discharged without the right care package, they’re back into hospital.
When they’re discharged they’re still very unwell, they could harm themselves
Local government social worker Dick
Cathy said, “Sometimes you’ll lose a fight with a consultant about someone being sent home. We sometimes look at admissions to see if they’ve been brought back—and quite often they have.”
After patients are discharged from hospital, they will have care provided by the local authority.
Dick, a local government social worker, is one of the people who do this. “Most of the referrals to our service have been in an acute hospital,” he told Socialist Worker.
“If they have been assessed as requiring housing with support, then they will be sent to us.”
He said that the pressure to discharge people is putting massive strain on social services already cut to the bone—and it’s making seriously ill people worse. “Because the drive is to shift people as soon as possible, we get people who are so unwell and unstable,” he said.
“Everyone feels that the threshold for people being discharged has gotten a lot lower. It’s not that the staff at hospitals don’t care, there’s just a big pressure on beds.
“We’ll sometimes get a call from the borough director of the hospital asking, ‘Can you get this person discharged because we’re out of beds?’”
This can sometimes put discharged patients in danger. Dick explained, “When they’re discharged they’re still very unwell, their behaviour could be erratic and they could harm themselves or someone else.
“They go into supported accommodation, there’s an incident—then they’re readmitted into hospital.”
For that person, the cycle begins again. To break it, will mean breaking the cycle of cuts and privatisation the Tory government and local authorities are inflicting on the NHS and social care.
The Tories claim they are boosting funding as they integrate health and social care services. But this so-called integration is breaking up the NHS, prising it open for privatisation and leaving a care crisis in its wake.
Their claim that the Better Care Fund (BCF) will improve care is a large swindle.
The fund was set up with £2 billion taken from the overstretched NHS budget. Instead of helping integration it is fuelling the crisis caused by huge social care cuts.
Both services are suffering a funding crisis and robbing from one to patch up the other is nonsensical.
Rather than being a solution it has only made the problem worse. Last December NHS England’s chief nurse argued to further slash the number of beds to boost “primary care”.
In the BCF’s first year not only did hospital admissions go up instead of down but the number of delayed discharges also increased—the opposite of what was meant to happen.
Despite another £1.5 billion for the BCF the Tories’ claim it will lead to a rise in social care spending by 2020 was even rubbished by the Tory-run Local Government Association. It said the funding gap of £700 million would only get worse.
Now local councils are being allowed to raise council tax by 2 or 3 percent for each of the next three or two years respectively. This would raise £543 million but social care needs £1.1 billion more just to maintain its current inadequate levels.
The problem is compounded by how the Tories are restricting access to social care service.
As Dick explained, “Social care isn’t about people’s quality of life anymore—it’s about surviving.
“Before, if people were seen as having mental health or care needs they’d be entitled to the service. But now if they don’t meet the strict criteria, they don’t have to get care.”
This twin crisis will get worse under Sustainability and Transformation Plans (STPs), being unleashed on the NHS by the Tories.
STPs aim to slash £22 billion and hundreds of hospital departments and services across England by 2020-21.
Even the money set aside to implement the STPs is mostly going towards plugging massive deficits at NHS trusts managing crisis-ridden hospitals and health services.
Closer integration between services to ensure people do not fall through the net and receive the care they need is worth supporting.
But a key part of the STPs is shifting the burden of care onto primary care services, services provided in the community that are under massive strain already.
The Tories’ plans will do nothing but harm patient care.
We must resist them to defend and extend the public health and social care services people need.
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